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Am. J. Trop. Med. Hyg., 73(4), 2005, pp. 657-661
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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Right arrow Melioidosis

SHORT REPORT


THE ROLE AND SIGNIFICANCE OF SPUTUM CULTURES IN THE DIAGNOSIS OF MELIOIDOSIS

DIANA HUIS IN ’T VELD, VANAPORN WUTHIEKANUN, ALLEN C. CHENG, WIRONGRONG CHIERAKUL, WIPADA CHAOWAGUL, ANNEMARIE E. BROUWER, NICHOLAS J. WHITE, NICHOLAS P. J. DAY, AND SHARON J. PEACOCK*
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Flinders University, Darwin, Australia; Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Department of Internal Medicine and Infectious Diseases, St. George’s Hospital Medical School, London, United Kingdom; University Medical Centre Nijmegen, The Netherlands; Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

 

ABSTRACT

Pneumonia is a common manifestation of melioidosis, the disease caused by Burkholderia pseudomallei. In this study, we defined the prognostic significance of a positive sputum culture. A total of 712 patients presenting to Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, with melioidosis between January 1992 and December 2002 had a sputum culture performed during admission, which was positive for B. pseudomallei in 444 patients (62%). The median duration of sputum positivity was 9 days (range, 1 to 49 days). Sputum cultures were negative in 32% of patients with radiologic changes suggestive of pulmonary involvement. Overall in-hospital mortality was 48%. A positive sputum culture was associated with mortality (adjusted OR 2.8, 95% CI: 1.9, 4.0; P < 0.001). This was independent of renal disease, a prior history of melioidosis, positive blood cultures, and other potential confounders. The presence of B. pseudomallei in the sputum of patients with melioidosis is associated with a poorer prognosis.

Received February 20, 2005. Accepted for publication June 15, 2005.

Acknowledgments: We are grateful for the support of the staff at Sappasithiprasong Hospital and the Wellcome Trust-Mahidol University-Oxford University Tropical Medicine Research Program.

Financial support: A. C. was supported by an Australian National Health and Medical Council Training Scholarship, S. J. P. by a Wellcome Trust Career Development Award in Clinical Tropical Medicine, and A. E. B. by a Wellcome Trust Training Fellowship. This study was funded by the Wellcome Trust of Great Britain.

* Address correspondence to Sharon J. Peacock, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Phayathai, Bangkok 10400, Thailand. E-mail: Sharon{at}tropmedres.ac

Authors’ addresses: Diana Huis in ’t Veld, Vanaporn Wuthiekanun, Wirongrong Chierakul, Nicholas J. White, Nicholas P. J. Day, and Sharon J. Peacock, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Phayathai, Bangkok 10400, Thailand, Telephone: +66 2 354 9172, Fax: +66 2 354 9169. Allen C. Cheng, Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Flinders University, Darwin, Australia, P.O. Box 41096, Casuarina NT 0811, Australia, Telephone: +61 8 8922 8196, Fax: +61 8 8927 5187. Wipada Chaowagul, Medical Department, Sappasithiprasong Hospital, Thanon Sappasit, Muang District, Ubon Ratchathani, Thailand, Telephone: +66 1 8765372, Fax:+66 4 524 6112. Annemarie E. Brouwer, Department of Internal Medicine and Infectious Diseases, University Medical Centre Nijmegen, The Netherlands. Telephone: +31 24 3614763, Fax: +31 24 3541734.

Reprint requests: Sharon J. Peacock, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Phayathai, Bangkok 10400, Thailand, Telephone: +66 2 354 9172, Fax: +66 2 354 9169, E-mail: Sharon{at}tropmedres.ac.






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Copyright © 2005 by the American Society of Tropical Medicine and Hygiene.